A “ping-ping” rings out lightly but distinctly as my call with Norton Healthcare connects. A few seconds later a video appears on my phone of three women: Lynne Choate, public relations manager; Jennifer Murley, director of health care informatics; Rachel Alexander, APRN manager of telehealth, who are in a Western Kentucky hospital as I sit in my dining room 2 ½ hours away.
This interaction is the future of health care in Kentucky. We are using Zoom, an app that has become a familiar tool for commonwealth telemedicine. According to its website, Zoom “reliably delivers consistent clinical user experiences, seamlessly integrates into (provider) technology and workflows, and keeps (hospitals) connected and compliant. With high-quality video, even in low-bandwidth environments, organizations can support health care teams and patients around the globe.”
The Zoom app is one link in a long chain that is telemedicine in Kentucky today. The state was one of the first in the nation to open its arms to telemedical development in 2000 by authorizing physician use of telehealth, creating the Kentucky Telehealth Board to develop the Kentucky Telehealth Network (KTN), and prohibiting insurers from excluding such technologies.
“The technology really is not new at all,” said Nick Sarantis, ATC System director of digital health at Baptist Health. “In 2000 Kentucky first mandated reimbursement for telehealth by the Department of Medicaid. The new legislation that went into effect on July 1, 2019, removed the barrier of having to have both the patient and provider be approved by the Kentucky Telehealth Board, provided additional clarity on where the patient can be located (clinic, school, home, business), and added additional information regarding store and forward or asynchronous telehealth options.”
Definite progress, according to professor Robert Caudill, M.D., director of telemedicine and information technology programs in the Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine.
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“I put together a business plan in the early 2000s that recognized the misallocation of resources in the state. As a community psychiatrist at the time, I related to the great difficulty my colleagues in rural settings were having in recruiting and retaining quality medical staff,” Caudill said. “While we (at UofL) were not exactly overstaffed, we definitely had resources we could redeploy. The implementation of a technology solution to help these rural clinics with their staffing issues made perfect sense.”
Adoption of telemedicine into Kentucky’s health care landscape proved to be an insightful move on the part of commonwealth legislators and bore fruit with hospitals across the state.
“In 2013,” Murley said, “Norton Healthcare started to add some telemedicine services with specialty providers to our affiliate hospitals – for example, cardiology, pulmonology, infectious disease and neurology. These providers do remote consults for patient in outlying, rural areas in Kentucky and Indiana that we are affiliated with.”
UofL took a similar course, Caudill said.
“The Department of Psychiatry at the University of Louisville became actively involved in telepsychiatry around 2009. We started with some child psychiatry services provided to Western Kentucky clinics. It rapidly grew. We are constantly looking at additional ways to expand services.”
And health care providers are doing their part to help patients adapt to the new technology as well, Norton’s Murley explained.
“Our providers work very carefully with our patients to ensure they have a great experience with our telehealth services. Connectivity is obviously a big part of that and so we do quite a bit of hand-holding in the beginning to ensure our patients understand the technology,” she said. “If the patient is having difficulty, we’ll call them on the phone and talk them through other telehealth options such as coming off of their Wi-Fi and going on their data plan or switching from a computer to a mobile device. We have a whole list of troubleshooting techniques that we go through with the patient.
“We’re aware the first telemedical visits might take a little bit longer until we really get the technology piece worked out with the patient. But we find that once we explain everything to the patient, if they ever use the services again, they don’t have the same difficulty because they’ll go right to what we found that works best after we do the troubleshooting.”
In response to the growth of Kentucky telemedicine, legislators took further steps in spring 2018 to expand the state’s embrace of telemedicine with the Telehealth Law SB 112, which further solidified the requirements that insurers cover telemedicine as well as looping Kentucky Medicaid into the new system and clarifying many telemedical rules and regulations across the board.
Federal and state government, as well as health care foundations, are helping hospitals grow Kentucky’s telemedical technology. Owensboro Health announced in November 2019 that “OH has received a $460,820 federal grant for a new telemedicine project that will allow regional patients to consult with the health system’s specialists without making a trip to Owensboro.” The grant “will provide telecommunications units at 10 sites. Cities with access to OH telehealth services will be Greenville, Powderly, Calhoun, Madisonville, Beaver Dam and Tell City, Indiana” and should be available by March 2020.
Similarly, Kentucky Rural Healthcare Information Organization (KRHIO) has been working the past year to expand behavioral health care coverage in Eastern Kentucky through a $495,851 grant from USDA’s Distance Learning and Telemedicine Program to expand telehealth services to 24 sites and 13 communities.
“So many patients don’t receive the care they need,” KRHIO Executive Director Andrew Bledsoe said in a 2018 interview, “because they can’t afford to travel to the bigger cities, or they don’t have a way to get there. Telehealth can eliminate this burden and allow people to get the help they need.”
Pathways Community Mental Health Center also received a three-year $930,000 grant in 2019 from the United Health Foundation to expand its telehealthcare services for more than 3,000 children in 10 Eastern Kentucky counties. Pathways will develop technology at 16 outpatient offices and specialty residential units in the region to connect children to child and adolescent psychiatrists hours away and remove the requirement that families drive 2½ hours for counseling.
“The No. 1 barrier to care in this part of Kentucky is always transportation. If you can’t get there, you can’t get the care,” Pathways CEO Dr. Kimberly McClanahan told WEKU radio in an interview.
Connecting to better health
Telemedicine is also a great tool in providing vital early response for stroke patients, Baptist Health’s Sarantis said.
“Utilizing telehealth allows hospitals to provide specialty care in smaller hospitals that otherwise could not provide that type of care. Stroke is a great example since without the early diagnosis and administration of the drug TPA, the patient could suffer very serious consequences, longer hospital stays, longer rehab, etc.,” he said.
“This same patient also might have to be transferred to another hospital, which again could lead to higher costs. The ability for that patient to receive quick and quality specialty care in one location is the best for the patient and the most efficient way to provide care,” Sarantis said. “Baptist Health Madisonville has a teleneurology program with the University of Louisville to provide 24/7 consultation with stroke specialists.”
Hospitals and providers, with legislative encouragement, are enthusiastically embracing the new technology, and the Kentucky Wired project is slowly pushing bandwidth into all areas of the state. But some areas of technology infrastructure do still need to catch up if telehealth is to achieve its potential.
“There have been technology limitations, especially with connectivity requirements for telemedicine infrastructure,” said Francis DuFrayne, M.D., chief medical officer at Owensboro Health. “Currently telecommunications vendors within the state do not have the infrastructure to support 5G bandwidth.”
According to broadbandsearch.net, internet options for Kentucky remain less than the national average, with 35.4% of Kentuckians having 25 Mbps speeds or less; 6.5% with no wired internet access available; and 5% underserved or with minimum internet services available, which leaves 34.2% of Kentuckians without effective access to the internet.
With a third of the state still lacking access to telemedicine on a direct patient-to-provider internet channel, hospitals are lobbying to expand internet infrastructure to the benefit of health care as well as other business needs. Meanwhile, telemedicine opened up the option of providing coverage over the phone, so rural Kentuckians limited to landline communication still have the option to get telehealth coverage while the technology infrastructure catches up.
It is not just patient-to-provider care that telemedicine encompasses. The scope of telemedical technologies has become expansive both in Kentucky and nationally and includes specialists and large hospitals to smaller regional hospitals, and providers to nonmedical organizations such as schools and jails.
Dr. Ralph Alvarado, a state senator, took note of the cost-saving potential at the 2019 Telehealth Summit.
“It’s going to help reach people in our jail settings and in our school settings as well as hopefully help reduce the number of ER visits and expand access for patients to specialists, such as mental health specialists. We have a shortage of all of these things in our state.”
Virtual reality used in health care solutions
The health care industry is continually progressing thanks to advances in technology, such as improved diagnostic testing, the use of robotics in surgery and quicker access to care through telemedicine.
BehaVR, a tech company founded in 2016 by former Humana executive Aaron Gani, is using virtual reality (VR) technology to treat patients suffering from addiction, anxiety, depression and chronic pain.
“Virtual reality is uniquely psychologically and neurologically powerful for addressing behavioral health conditions, which are neurologically based,” Gani said.
Through personalized educational content, emotional regulation skills and stress resilience techniques, BehaVR’s programs use the immersive power of virtual reality to create experiences that motivate and activate healthy behavior change.
“We offer programs that provide educational nodules, motivational interviewing, motivating patient narratives from others who have experienced similar health challenges, mindfulness practice, emotional regulation practices, and elements of cognitive behavioral therapy (CBT),” Gani said.
Gani saw firsthand just how prevalent behavioral health challenges were while working at Humana, he said. He also saw that the range of available treatments were costly and not always effective. Gani created BehaVR to help patients experience sustained behavior changes, one of the toughest challenges in health.
“When a person suffers both from one or more chronic diseases and a behavioral health challenge such as unmanaged stress, anxiety, depression, pain or substance use disorders, they become even more challenged and two to three times more expensive to care for, so it’s a huge area of spending, as well as pain and suffering,” he said.
As a “lifelong technologist,” Gani said he knew in 2016 that virtual reality was about to enter the consumer-grade era because of the Oculus VR headset and the company’s acquisition by Facebook. It was the perfect time to try to harness the psychological power of virtual reality, building on more than 20 years of work by medical VR researchers.
“Our brains use inputs from our senses to maintain a model, or simulation, of our current state – where we are, how we feel, what we’re doing, whether we’re comfortable, safe or in danger, etc. When we replace or ‘hijack’ those sensory inputs using VR, we create a new reality for our brain in those moments – we create experiences,” BehaVR explains on its website. “By designing experiences that elicit emotional and physiological responses, and teach concepts through engaged and embodied learning, we have incredible power to impart new insights and mental models.”
More than 100 clinical sites across the country are currently using BehaVR’s treatment programs. The company also is developing VR programs to address other health issues.
BehaVR has 15 employees and is headquartered in Elizabethtown. It has a second office in Nashville. The company recently was accepted into the Endeavor Global network, a nonprofit organization that focuses on building scalable companies and cultivating entrepreneurial ecosystems around the world. Endeavor Global selects entrepreneurs who demonstrate the potential to create large-scale wealth and jobs, and are committed to reinvesting their time and money in their local entrepreneurship communities.
Clary Estes is a correspondent for The Lane Report. She can be reached at [email protected]